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Mining an ePR system using a treatment plan navigator for radiation toxicity to evaluate proton therapy treatment protocol for prostate cancer

MINING AN EPR SYSTEM USING A TREATMENT PLAN NAVIGATOR FOR
RADIATION TOXICITY TO EVALUATE PROTON THERAPY TREATMENT
PROTOCOL FOR PROSTATE CANCER
by
Anh Hong Tu Le
A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(BIOMEDICAL ENGINEERING)
August 2010
Copyright 2010 Anh Hong Tu Le

Radiotherapy (RT) is an image-intensive specialty in medicine that utilizes radiation for treatment of cancer. Similar to x-ray beam treatment, proton therapy (PT) utilizes high energy particle proton beam to kill cancer cells at the target region. Due to the physical properties of the proton beam, PT delivers dose with higher accuracy than conventional radiotherapy with x-ray beams and no exit dose. In PT, patient data are scattered in different systems within the oncology department which hinders the research on many topics such as whether PT with higher dose or different delivery schedules is more beneficial to reducing toxicity of prostate cancer patients. This research aims to introduce a data mining method and a treatment plan navigator utilizing the infrastructure and data repository of a PT electronic patient record (ePR) system that can ultimately help to minimize radiation toxicity in prostate cancer patients and improve patient outcomes in future proton therapy treatment.; The workflow of a proton therapy treatment in oncology department was reviewed, and a clinical data model and data flow was designed. A prototype PT ePR system compliant with Digital Imaging and Communications In Medicine (DICOM) was developed to store prostate cancer patient images, treatment plans and related clinical data. The ePR system consists of four main components: 1) Data Gateway; 2) ePR Server; 3) Decision Support Tools; and 4) Visualization and Display Tools. The decision support tools and visualization tools are currently developed based on DICOM images, DICOM-RT and DICOM-RT-ION objects with collaboration with James M. Slater, M.D. Proton Treatment and Research Center, Loma Linda University Medical Center (LLUMC) and its oncologists and physicists. The data from prostate cancer patients treated with hypofractionation protocol proton therapy at LLUMC was used for evaluating the effectiveness of the ePR system. Each patient dataset includes a set of computed tomography (CT) DICOM images and four DICOM RT and RT-ION objects. In addition, clinical outcomes data collected from PT cases were included in the overall database to form a knowledge base for future outcomes analysis. A data mining search engine and an intelligent treatment plan navigator (ITPN) has been developed and integrated with the ePR system to utilize the knowledge base and data for decision support, which was evaluated using a hypothetical patient.; In general, the ePR system with centralized data shows promise in its ability to facilitate the proton therapy workflow. The scope of the PT ePR system in this dissertation is for prostate cancer patient treated with hypofractionation protocol in proton therapy. The system was evaluated with 41 patients collected for this protocol. The goals of my research in the ePR System for prostate cancer patients are: (1) design a system based on the above specifications tailored to proton therapy, (2) to improve efficiency in data collection and integration to facilitate outcomes analysis with this system and (3) to utilize knowledge extracted from the collected data to help clinical decision making process for a better treatment plan of prostate cancer patient treated with new hypofractionation treatment protocol.

MINING AN EPR SYSTEM USING A TREATMENT PLAN NAVIGATOR FOR
RADIATION TOXICITY TO EVALUATE PROTON THERAPY TREATMENT
PROTOCOL FOR PROSTATE CANCER
by
Anh Hong Tu Le
A Dissertation Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(BIOMEDICAL ENGINEERING)
August 2010
Copyright 2010 Anh Hong Tu Le